Combination of probenecid-sulphadoxine-pyrimethamine for intermittent preventive treatment in pregnancy

The antifolate sulphadoxine-pyrimethamine (SP) has been used in the intermittent prevention of malaria in pregnancy (IPTp). SP is an ideal choice for IPTp, however, as resistance of Plasmodium falciparum to SP increases, data are accumulating that SP may no longer provide benefit in areas of high-level resistance. Probenecid was initially used as an adjunctive therapy to increase the blood concentration of penicillin; it has since been used to augment concentrations of other drugs, including antifolates. The addition of probenecid has been shown to increase the treatment efficacy of SP against malaria, suggesting that the combination of probenecid plus SP may prolong the useful lifespan of SP as an effective agent for IPTp. Here, the literature on the pharmacokinetics, adverse reactions, interactions and available data on the use of these drugs in pregnancy is reviewed, and the possible utility of an SP-probenecid combination is discussed. This article concludes by calling for further research into this potentially useful combination

Music Therapy in Palliative Care

BACKGROUND: Music therapy has been used successfully for over 30 years as part of palliative care programs for severely ill patients. There is nonetheless a lack of high-quality studies that would enable an evidence-based evaluation of its psychological and physiological effects. METHODS: In a randomized controlled trial, 84 hospitalized patients in palliative care were assigned to one of two treatment arms--music therapy and control. The music therapy intervention consisted of two sessions of live music-based relaxation exercises; the patients in the control group listened to a verbal relaxation exercise. The primary endpoints were self-ratings of relaxation, well-being, and acute pain, assessed using visual analog scales. Heart rate variability and health-related quality of life were considered as secondary outcomes. The primary data analysis was performed according to the intention-to-treat principle. RESULTS: Analyses of covariance revealed that music therapy was more effective than the control treatment at promoting relaxation (F = 13.7; p \u3c0.001) and well-being (F = 6.41; p = 0.01). This effect was supported by a significantly greater increase in high-frequency oscillations of the heart rate (F = 8.13; p = 0.01). Music therapy did not differ from control treatment with respect to pain reduction (F = 0.4; p = 0.53), but it led to a significantly greater reduction in the fatigue score on the quality-of-life scale (F = 4.74; p = 0.03). CONCLUSION: Music therapy is an effective treatment with a low dropout rate for the promotion of relaxation and well-being in terminally ill persons undergoing palliative care

Die Movement Assessment and Reporting App (MARA) in der Musiktherapie

Under the present demands for digitalization, it seems timely for creative arts therapies (CATs) to create a state-of-the-art, reliable and easy-to-use digital assessment and documentation tool. This study examines the suitability of Movement Assessment and Reporting App (MARA) and its according outcomes framework, originally developed, and used by dance movement therapists (DMTs), for music therapy (MT). We tested the hypothesis that MARA, its underlying outcomes framework, with the domains: 'physical', 'cultural', 'emotional', 'cognitive', 'social', and 'integration', are meaningful for MT assessments. For the current study the following questions were defined: Is MARA suitable as a documentation and evaluation tool for other CATs taking the example of MT? What are possible difficulties occurring for music therapists (MTs) using MARA? What changes need to be made to make MARA's outcomes framework supportive for MTs? In an exploratory pilot study, five MTs completed an extensive assessment of two clients with autism spectrum disorder, testing MARA and the outcomes framework with a questionnaire developed by the research team. Results suggest that MARA as well as the outcomes framework can be transferred to MT, with a few adaptations particularly in the items of the 'physical' domain. Findings were compared to existing MT assessment tools, such as MAKS, IMCAP-ND, MATADOC, IAPs, AQR and the Creative Music Therapy Evaluation Scales. Adaptation suggestions for MARA and the outcomes framework for MTs are discussed. Technology offered and used by MARA was considered as a potential for the future use in clinical and research work. Through the use of (technology-based) assessment and evaluation tools therapists can enrich the communication with other health disciplines and make the benefits of MT more accessible, to offer the best support for every individual client.Unter den gegebenen Anforderungen und Wünschen nach Digitalisierung im Feld der klinischen Psychologie und Therapiewissenschaften, erscheint es ratsam für die künstlerischen Therapien (CATs) ein zeitgemässes, reliables und benutzerfreundliches Dokumentations- und Evaluationsmessinstrument zu entwickeln. Diese Studie untersucht, ob Movement Assessment and Reporting App (MARA), deren unterliegendes outcomes framework mit den Domänen: 'physical' (körperlich), 'cultural' (kulturell), 'emotional' (emotional), 'cognitive' (kognitiv), 'social' (sozial), und 'integration' (integrativ), welches ursprünglich für die Tanz- und Bewegungstherapie (DMT) entwickelt wurde, auch für Erhebungen und Dokumentationen in der Musiktherapie (MT) genutzt werden kann. Eignet sich MARA als Dokumentations- und Evaluationsmessinstrument für weitere CATs, hier die MT? Welche Schwierigkeiten könnten sich in der Verwendung von MARA für Musiktherapeutinnen und -therapeuten (MTs) zeigen? Welche Anpassungen müssten an MARAs outcomes framework vorgenommen werden, um dieses gewinnbringend und unterstützend in der MT einsetzen zu können? Fünf MTs nahmen an dieser Pilotstudie teil. Sie beantworteten einen ausführlichen Fragebogen zu Patientenvideos mit Klienten des Autismus-Spektrums, mit MARA und dem outcomes framework. Die Ergebnisse legen nahe, dass MARA und das outcomes framework in die MT sowie weitere CATs übertragen werden könnten. Notwendige Anpassungen für diese Übertragung sind insbesondere in der ersten Domäne ('physical') der körperlichen Merkmale nötig. Die Ergebnisse wurden mit bestehenden Messinstrumenten der MT, wie dem MAKS, IMCAP-ND, MATADOC, IAPs, EBQ und den Creative Music Therapy Evaluation Scales verglichen. Anpassungsvorschläge für MARA und das outcomes framework für die Verwendung in der MT werden im Artikel diskutiert. Die Technologie, welche MARA nutzt, enthält laut der Einschätzung der Studienteilnehmerinnen Potenzial für den Gebrauch im klinischen Alltag wie auch für Forschungszwecke. Durch die Verwendung von (Technologie gestützten) Dokumentations- und Evaluationsinstrumenten kann die Kommunikation von MTs mit weiteren Mitarbeitenden der Gesundheitsberufe vertieft und der Zugewinn durch die MT untermauert werden. Dadurch kann die beste Unterstützung für jede individuelle Klientin/ jeden individuellen Klienten gestärkt werden